Why we need imagination in medicine
In Edendale hospital, KwaZulu Natal, South Africa – just a stone’s throw away from where Nelson Mandela made his last, rousing speech before imprisonment – they are fighting a new and different battle against an ever-evolving, terrifying enemy: TB.
Recently, TB has been on the decline, with scientists and physicians alike allowing themselves to imagine a world without it, but with the unprecedented explosion in cases of HIV, particularly in areas such as KwaZulu Natal, TB has returned with a vengeance. This escalation is all the more worrying because with it comes new killers – multi drug-resistant and extensively drug-resistant TB – that have caused the debilitating illness to leap back into the international arena. Suddenly, an illness which was curable by a long, yet simple course of relatively cheap medications becomes one with very limited and expensive medical options, simply because people were not taking the right medications for the right amount of time.
TB and HIV are often partnered together. Both devastating illnesses, HIV has the ability to reduce the body’s own defences, giving TB more of a chance to take hold. TB starts with a terrible cough – sometimes blood-filled – and night-sweats so bad that sufferers complain of completely drenching the sheets. If left untreated, the cough can worsen to the point where moving is too much effort for already laboured breathing, and if oxygen and drugs are not available, many patients are physically unable to cope with this for very long. The chance of travelling this horrific, and relatively long, road to death is increased if the patient is co-infected with HIV and if their access to medicine and enough food to strengthen their struggling bodies is hampered. Unfortunately, this is the case in many areas around the world.
Why is this happening and why are doctors and drug companies struggling to stop the onslaught of a disease that does have a recognized, drug-based cure? You have to work with a society, rather than impose a formula on it, grid-like. The science and pharmacology supporting HIV are sophisticated and extraordinarily advanced: drugs now work so well that a person in Britain with HIV has a longer life-expectancy than someone with diabetes, if they take their medication correctly. However, the procedure that works in Britain and other Western states appears to be failing in many less-developed countries because it is not flexible and it does not recognize local needs. Drugs might be theoretically available to those dying of TB, but people in rural areas simply cannot get the medication that would save them: they cannot afford to travel all the way to clinics rather than collect their water and find their food for the day. Short-term needs override longer-term ones.
The best medicine is not just scientific and rational, it is also imaginative, empathetic, adaptive to social and political needs and culturally specific. It works with the grain of psychology rather than against it, and is where science meets humanity, where reason takes the fears and deep-held beliefs of the individuals it treats into account. The fight against this new onslaught of TB cannot just be fought by science; we need inventiveness and a spirit of adventure as well.
Just 285 kilometres away from the fight raging in KwaZulu Natal is Lesotho, otherwise known as the Kingdom in the Sky, and home to the second-highest proportion of TB sufferers globally. Perhaps the sheer level of disease and death has led to the inspiring programme that is being carried out, that is saving countless lives and giving hope to a suffering region. Men on horseback courier sputum samples from men, women and children round the country to be tested; healthcare teams communicate results by text. This poignant utilization of culture, local norms and new technology is saving lives, boosting economies, and should be making headlines.
If the people can’t get to the help, the help must get to the people. Clinics designed to travel to patients, with ambulances made from all-terrain jeeps, deliver medical supplies and testing to the most far-flung corners of countries that have no roads, no infrastructure. Medicine cannot work without cultural, geographical and psychological knowledge. People are not dying of HIV and TB because there is no cure: they are dying of it in part because medicine can be stubbornly inflexible. This must change. Medical science has made extraordinary advances, but it does not work on its own. It is only half the battle: we need humanity, psychology, and imagination, and then we can win the war.
Anna Hughes, a university of Manchester medical student is the winner of the RESULTS UK and Student Stop AIDS Campaign global health blog competition. She will be joining a delegation to South Africa to learn more about TB/HIV and how people affected by the diseases can use their voice to advocate for change.